The Practice of Self-Injury

Written by: Katie Leboeuf, M.A. — CIGNA Behavioral Health

We all remember our younger yesterdays, the days when life was "simple." A "bad" day may have constituted falling down and skinning your knee, the pain sharp, but in moments a parent runs to your side with a band-aid and kiss, and all is better. But life is never simple, we will skin our knees, have our arms and hearts broken, and often there will be no one to come to our rescue. Much of what hurts us as young adults, adults, and even into our elder years is a pain that simmers inside, one that cannot be seen with the naked eye or even an X-ray. This pain or emotional upheaval can create a world that is no longer "simple" but rather scary, difficult, and at times tragic. Television and the internet, along with many people crusading for mental illness, have brought to our attention the importance of understanding, accepting, and caring for ourselves and our mental wellness. But even with a heightened awareness of mental illness, and with technology that brings all information to our fingertips within moments, there are millions of silent sufferers, especially teenagers, who are not getting the help they so desperately need.

A disturbing situation has emerged among teens: the practice of self-injury or self-mutilation. Called the new age anorexia, the practice of self-abuse or mutilating behavior is on the rise. Teenagers who self-mutilate — overwhelmingly girls — are inflicting pain and injuries on their own bodies. It is estimated that one out of every 200 teen girls between the ages of 13 and 19 regularly practice self-abusive behavior with a reported 2 million cases in the US alone (PageWise, 2002). Overall approximately 1% of the United States population uses physical self-injury as a way of dealing with overwhelming feelings or situations. The emotional issues that drive people to self-harm — and the physical fall-out from such practices as cutting and burning — make self-mutilation a serious problem and one that cannot be ignored.

If we are to begin addressing this problem, we must first acknowledge and attempt to de-stigmatize it. People who discover that relatives or friends are in the habit of furtively cutting, burning, or harming themselves often react with horror. It can be frightening to witness the scars and wounds. For the outsider looking in, it is difficult to comprehend why someone would want to hurt themselves in such a dramatic and violent manner. But the looks of horror, the whispers behind a person's back, the unfair judgments work only to reinforce the behaviors because they also reinforce the individual's belief and shame that something is really wrong with their minds and bodies. Self-injurers are not "crazy," they are not "attention seekers," they simply do not know how to better cope or have not learned how to handle some of the extreme emotions that they are experiencing. These behaviors are a sign of great inner pain and should be addressed immediately and appropriately. For true healing to begin, the self-injurer needs to feel accepted by family members and not judged for their behavior.

Self-injurious behavior is not a new phenomenon to the human existence, but it is only of late that we have begun to talk about it. It's called many things — self-inflicted violence, self-injury, self-harm, parasuicide, delicate cutting, self-abuse, and self-mutilation. Broadly speaking, self-injury is the act of attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to one's body (Martinson, 2003). There are several types of self-abusive and mutilating behaviors. They include cutting, burning, wound interference and picking. Cutting is just as it sounds. The individual will use a razor blade, knife, broken mirror or a piece of glass, whatever they can find, and cut their skin allowing it to bleed openly for several minutes. Burning is the practice of placing cigarettes, hot metal, lighters, or lit matches to the skin and causing a burn. The practice of wound interference is done by creating a wound, whether it is a cut, burn, bruise, or bump and preventing it from healing by tearing, picking, or pushing on the wound. Picking is done when a self-mutilator literally picks at their skin until a wound is created and bleeds.

It is also important to note and recognize what is not self-injurious behaviors. It's not self-injury if the primary purpose of the behavior is for sexual gratification, body decoration (e.g. body piercing, tattooing), spiritual enlightenment via ritual, or fitting in or "being cool." Many teens go through "phases" or "fads" in which groups of people may find it neat to use an eraser to "burn" the name of their boyfriend or girlfriend onto their arm, or use a lighter or cigarette to mark a "party-dot" onto their palm to signify their attendance at a party. While worrisome, these behaviors are not symptoms of self-injury or self-mutilation. The teens that self-abuse are not necessarily the ones who get numerous tattoos or piercings; it is actually very difficult to identify a person who practices self-abusive behaviors out of a high school full or teens or a crowded bus of commuters. People who self-abuse have become very adept at keeping their "secret." The incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses ready when someone asks about the scars.

Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; straight, gay, or bisexual; Ph.Ds, high-school dropouts or high-school students; rich or poor, from any country in the world. Some people who self-injure manage to function effectively in demanding jobs; they are teachers, therapists, medical professionals, lawyers, professors, and engineers. Some are on disability. Cutting usually begins during puberty and lasts 5 to 10 years. But it can go on much longer if left untreated. Those that practice these self-abusive behaviors do so in an attempt to release stress, pain, fear or anxiety. Overwhelmingly practiced by teen girls, boys and men are affected too. At least 11 thousand boys a year cope by causing self-injury. What all self-injurers have in common is the emotional need or desire to regain control in their life. If they begin to feel they are losing control of their life, the cutting or self-injury behaviors can be an attempt to regain that control over unbearable feelings of aloneness, loneliness, and helplessness. When a person has not learned healthy ways of managing these intense feelings, they may turn to physical pain as a way to dull the emotional pain or gain a sense of control over the pain they are feeling.

Studies have suggested that when people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable baseline level almost immediately. In other words, they feel a strong uncomfortable emotion, don't know how to handle it (often do not even have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely quickly. They may still feel bad (or not), but they don't have that panicky, jittery-trapped feeling; it's a calm bad feeling instead (Martinsen, 2001). The emotional pain is so bad and so debilitating, that a young teen or adult would actually choose to hurt themselves in order to get even just a bit of relief — or "calm bad feeling." The concept of having "good" feelings is so foreign that a person will settle for "slightly bad" if it means a moment of peace from the other pain. Those who self-mutilate often feel they can't express themselves verbally or otherwise. As these feelings remain inside, they build up to dangerous levels and can eventually result in self-mutilating behavior. Dr. Margaret Paul, therapist and co-author of Healing Your Aloneness, a book that examines self-mutilation is quoted in Carma Shoemaker's article "A Cut Above" as saying, "Cutting is physically painful — it hurts. But to a mutilator it's absorbing. It's doing something. It's controlling something. It's causing something. It's making it happen and not being at the effect of outside forces over which they have no control (Shoemaker, 2004)."

Learning that someone you care about is self-mutilating can bring about feelings of helplessness. Parents, spouses, or friends may discard the teens or self-injurer's altered behavior as a phase or something that will pass. And because the behavior is "taboo" or "weird" it may be a difficult topic to address. Families may fear that if they talk about the behaviors the self-mutilator will escalate or cause further harm to themselves, maybe even attempt suicide. It is important to know though that these behaviors are not attempts at suicide. Self-injury is a maladaptive coping mechanism, a way for these individuals to stay alive.

People who self-injure generally do so because of an internal dynamic, and not in order to annoy, anger, or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers or loved ones. "Self-mutilating behaviors, as well as eating disorders, drug or alcohol use and extreme violent behavior are all cries for help," Dr. Paul says. "These kids are saying, 'I don't know what to do, so this is what I do instead. And don't try to take it away from me because it is all I have.'(Shoemaker, 2004)." If family begins to listen to the behaviors they will better be able to talk with the self-mutilator.

While a parent or friend or family member may feel helpless at times, there are signs a person can watch for if they suspect their loved one may be practicing self-mutilating behaviors. Unexplained or frequent injuries, wearing jeans, long pants or long sleeves consistently — even in warm or hot weather — exhibiting the want for isolation or "being alone" and the presence of blood stains on the inside of clothing may all be clues into a child's self-mutilating behavior (Pagewise, 2002).

There is hope and there is help. If you suspect your child, friend, or family member is self-mutilating there are several organizations that deal with self-abusive and mutilating behavior in an attempt to help those who harm themselves learn better coping mechanisms (See resource list below). Additionally many new therapeutic approaches have been and are being developed to help self-harmers learn new coping strategies and how to start using these techniques instead of self-injury. These approaches reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury. Also, research into medication that can stabilize mood, ease depression, and calm anxiety is being done; some of these drugs may help reduce the urge to self-harm (Martinson, 2001).

Bottom line — these behaviors will not disappear if left untreated. A band-aid may hide the cut on the outside, but it won't heal the hurt on the inside. Professional care and intervention is necessary.

For more information on self-injury and resources contact:

1-800-DON'T-CUT (800-366-8288)

SAFE Alternatives Program

Website: www.self-injury.net

Website: Self-Injury: You are not the only one. www.palace.net/~llama/psych/injury.html

Please note that CIGNA Behavioral Health is in no way associated with these resources, and does not endorse or guarantee references or sites listed. Also, no unfavorable inference should be drawn if a resource is not listed.

References:

Martinson, D. (2001). Self-Injury. Retrieved June 16, 2004, from www.focusas.com/SelfInjury.html

PageWise, Inc. (2002). What is self mutilation and other self abusive behaviors? Retrieved June 4, 2004, from www.ct.essortment.com/whatisselfmut_rfyb.htm

Shoemaker, C.H. (2004). A cut above: The practice of self-mutilation. Retrieved June 4, 2004 from www.teenagerstoday.com/resources/articles/mutilate.htm

Information in this document is taken from the resources cited and developed for use by the general public. It is not intended as medical/clinical advice or treatment. Only a healthcare provider can make a diagnosis or recommend a treatment plan. For more information about your behavioral health benefits, you can call the member services or behavioral health telephone number listed on your healthcare identification card.